Provider Demographics
NPI:1184606972
Name:QUINQUILLA, SUSANA ANGELICA (DENTIST)
Entity type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:ANGELICA
Last Name:QUINQUILLA
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE JOSE JULIAN ACOSTA
Mailing Address - Street 2:62B VEGA BAJA
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00063
Mailing Address - Country:US
Mailing Address - Phone:787-855-5336
Mailing Address - Fax:
Practice Address - Street 1:CALLES JOSE JULIAN ACOSTA
Practice Address - Street 2:62B VEGA BAJA
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00063
Practice Address - Country:US
Practice Address - Phone:787-855-5336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice